1
|
Kwiatkowski DM, Alten JA, Mah KE, Selewski DT, Raymond TT, Afonso NS, Blinder JJ, Coghill MT, Cooper DS, Koch JD, Krawczeski CD, Morales DL, Neumayr TM, Rahman AF, Reichle G, Tabbutt S, Webb TN, Borasino S. An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study. JTCVS OPEN 2024; 19:275-295. [PMID: 39015443 PMCID: PMC11247230 DOI: 10.1016/j.xjon.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 07/18/2024]
Abstract
Objective The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass. Methods This propensity score-matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation. Results Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, P = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, P = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations. Conclusions This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.
Collapse
Affiliation(s)
- David M. Kwiatkowski
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Jeffrey A. Alten
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kenneth E. Mah
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - David T. Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Tia T. Raymond
- Department of Pediatrics, Medical City Children’s Hospital, Dallas, Tex
| | | | - Joshua J. Blinder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Matthew T. Coghill
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - David S. Cooper
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joshua D. Koch
- Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, Ariz
| | | | - David L.S. Morales
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tara M. Neumayr
- Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - A.K.M. Fazlur Rahman
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala
| | - Garrett Reichle
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Sarah Tabbutt
- Department of Pediatrics, University of California – San Francisco School of Medicine, San Francisco, Calif
| | - Tennille N. Webb
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Santiago Borasino
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| |
Collapse
|
2
|
Slagle C, Askenazi D, Starr M. Recent Advances in Kidney Replacement Therapy in Infants: A Review. Am J Kidney Dis 2024; 83:519-530. [PMID: 38147895 DOI: 10.1053/j.ajkd.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 12/28/2023]
Abstract
Kidney replacement therapy (KRT) is used to treat children and adults with acute kidney injury (AKI), fluid overload, kidney failure, inborn errors of metabolism, and severe electrolyte abnormalities. Peritoneal dialysis and extracorporeal hemodialysis/filtration can be performed for different durations (intermittent, prolonged intermittent, and continuous) through either adaptation of adult devices or use of infant-specific devices. Each of these modalities have advantages and disadvantages, and often multiple modalities are used depending on the scenario and patient-specific needs. Traditionally, these therapies have been challenging to deliver in infants due the lack of infant-specific devices, small patient size, required extracorporeal volumes, and the risk of hemodynamic stability during the initiation of KRT. In this review, we discuss challenges, recent advancements, and optimal approaches to provide KRT in hospitalized infants, including a discussion of peritoneal dialysis and extracorporeal therapies. We discuss each specific KRT modality, review newer infant-specific devices, and highlight the benefits and limitations of each modality. We also discuss the ethical implications for the care of infants who need KRT and areas for future research.
Collapse
Affiliation(s)
- Cara Slagle
- Division of Neonatology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - David Askenazi
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Starr
- Division of Nephrology and Division of Child Health Service Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
| |
Collapse
|